Pneumoperitoneo_2011
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Transcript of Pneumoperitoneo_2011
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Imágenes en Pneumoperitoneo
Alberto Léon
R2 MIA
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Pneumoperitoneo: aire intra-peritoneal.
Causa + común: perforación. ej: úlcera, divertículo…
Otras Causas:
• Tumor, traumatismo, cirugía, procedimientos abdominales, iatrogénico, espontáneo etc..
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• Localizaciones gas abdominal:• INTRALUMINAL• GAS EXTRALUMINAL• INTRAPARENQUIMATOSO/ INTRAMURAL• INTRATUMORAL
• Leoiomioma o leiomiosarcomagastrico.
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Signos radiológicos + frecuentes
• Aire subdiafragmatico
• Signo de Rigler o de la doble pared:– segundo + frecuente, 32% de ptes
• Aire en la Rx lateral de abdomen
• Signo del Uraco
• Signo de V invertida ( ligamento umbilical lateral en supino)
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Signos radiológicos - frecuentes
• Aumento de lucidez hepática
• Aire en el espacio de Teres
• Colecciones de aire triangular o romboidal
• Aire en el espacio de Morison
• Aire en el ligamento falciforme
• Signo del futbol americano
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Mas frecuentes
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AIRE SUBDIAFRAGMATICO
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SIGNO DE RIGLER O DE DOBLE PARED
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SIGNO DEL URACO
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Menos Frecuentes
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HIPERLUCIDEZ HEPATICA
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SIGNO DE LA V INVERTIDA O SIGNO DEL LIGAMENTO LATERAL UMBILICAL
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AIRE EN EL ESPACIO SUBHEPATICO
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SIGNO DE LA PELOTA DE FOOTBALL
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AIRE EN EL ESPACIO DE MORISON
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AIRE EN EL ESPACIO DE MORISON
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COLECCIÓN CIRCULAR DE AIRE
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SIGNO DEL LIGAMENTO FALCIFORME
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•Rx - 24 h después de serie GI con bario.
•Bario en el espacio subfrénico
• Bario en surcos de vasos mesentéricos
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Imágenes
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• Rx post CPRE
•Ligamentofalciforme
• Signo de doble pared o Rigler
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• Rx tras CPRE
• Colección de aire subhepático
• Signo de Rigler
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• Perforación intestinal tras infarto intestinal.
•Airedentro del espaciovenoso portal.
• Aire subdiafragmatico
• Aire subhepatico
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• Aire subhepatico
• Signo del ligamentofalciforme
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•Signo del ligamentoTeres
•Signo del ligamento defalciforme
• Signo de Rigler
•Hiperlucidez hepática
•Aire subdiafragmático
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• Aire subdiafragmatico
• Signo de Rigler
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Falso Neumoperitoneo
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Atelectasias en la base pulmonar derecha
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Gran bulla en el campo pulmonar
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Interposición colónica -notar las Haustras
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• Desmesurado acúmulo de aire por debajo de hemidiafragmas por distensión de asas.
• Interposición de asa gruesa entre hemidiafragmas e hígado y bazo.
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Conclusiones
• Rx torax en bipedestación de primera elección
• Rx decúbito buscar los signos más frecuentes, correlacionar con la clínica y placa lateral si hay dudas
• Tomar en cuenta procedimientos previos
• Principales signos• Aire subdiafragmatico
• Signo de Rigler
• Aire en Rx lateral
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IMAGENES
Pneumoperitoneum: Imaging
Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK
http://emedicine.medscape.com/article/372053-imaging
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